TN 19 (03-93)

HI 00805.725 Equitable Relief for Certain CHAMPVA Beneficiaries

A. BACKGROUND - CHAMPVA PROGRAM

Shortly after the close of the enrollment period for CHAMPUS beneficiaries (see HI 00805.720), SSA was notified by the Veterans Administration (VA) that a similar situation existed with regard to beneficiaries of the Civilian Health and Medical Program of the Veterans Administration (CHAMPVA). This VA program provides or pays for medical care for an individual not entitled to CHAMPUS who is:

  • the wife or child of a veteran with a total, permanent service- connected disability; or

  • the widow or child of a veteran who either died as a result of a service-connected disability or at the time of death had a total, permanent service-connected disability.

As in the case of CHAMPUS, CHAMPVA beneficiaries lost entitlement upon becoming eligible for HI at age 65, but those under 65 entitled to HI were told they could retain CHAMPVA. Many felt it unnecessary to enroll for SMI and pay SMI premiums.

The change in interpretation of the CHAMPUS rules applied also to CHAMPVA: persons entitled to HI lost their CHAMPVA entitlement.

B. BACKGROUND - EQUITABLE RELIEF

The same relief given to CHAMPUS beneficiaries, a new enrollment opportunity, was given to CHAMPVA beneficiaries because these individuals also were discouraged from enrolling in SMI by the erroneous assurance that they could keep CHAMPVA despite HI entitlement.

CHAMPVA beneficiaries eligible for SMI, whose IEP ended prior to 7/78, were permitted to enroll for SMI between 1/1/78 and 6/30/78. SMI pursuant to such an enrollment began 7/1/78.

Following the general principles applied in CHAMPUS cases, an eligible CHAMPVA beneficiary enrolling in 1978 did not have months prior to 7/78 counted in determining whether (and how much) premiums would be increased for late filing. This rule applies even if the individual enrolls later than 6/30/ 78. However, months after 6/30/78 are counted in determining a premium increase.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600805725
HI 00805.725 - Equitable Relief for Certain CHAMPVA Beneficiaries - 03/17/1993
Batch run: 01/27/2009
Rev:03/17/1993